Medicare Claims Analyst Resume Example
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MEDICARE CLAIMS ANALYST
Work History
Medicare Claims Analyst, 07/2014
to 09/2016
Bottom Line Systems – City , STATE
Bottom Line Systems – City , STATE
- Confidently handled denials/appeals for outpatient/inpatient claims billed incorrectly or under paid.
- Posted and adjusted payments received from insurance carrier.
- Submitted electronic/paper claim documentation for timely filing.
- Interacted with providers and other medical professionals regarding billing/procedures/government regulations.
- Reviewed incorrectly billed claims to identify more appropriate coding based on CMS Regulations and guidelines.
- Researched CPT and ICD-9/ ICD-10 coding discrepancies for compliance and reimbursement accuracy.
- Actively maintaining knowledge of CPT/ICD-9/ICD-10 coding principles, government regulation, CMS guidelines, billing processes, coding requirements, through continuing education and certification renewals.
Claim Researcher , 12/2011
to 07/2014
Omnicare Inc – City , STATE
Omnicare Inc – City , STATE
- Rectified problems concerning coverage/billing to ensure pharmacy needs were properly met for patient/facility.
- Verified patient eligibility, coverage and claim status with insurance carrier.
- Trained new hires on system/programs/position requirements until full understanding of all processes.
- Obtained prior authorizations for coverage on patient\'s medications.
- Managed collection against estate of deceased patient.
- Evaluated financial status to appropriately set payment plans for patient.
- Treated patients, family members, pharmacy/facility staff and carrier reps with courteous, professional manner.
- Offered detailed explanation of plan coverage/processes, above job description, to provide excellent customer service.
- Acknowledged by management; received customer appreciation regularly.
- Awarded multiple times for excellent customer service.
Professional Summary
Medical Billing and Coding Specialist with 7 years experience. Strong ability to identify denied/under paid claim items needing appeal/correct claim. Organized professional able to adapt to changes within the Billing and Coding profession. Knowledge and experience to interpret contract language between provider/carrier.
Skills
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Education
Medical Claims and Billing degree : 2009
U.S. Career Institute -
U.S. Career Institute -
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Resume Overview
School Attended
- U.S. Career Institute
Job Titles Held:
- Medicare Claims Analyst
- Claim Researcher
Degrees
- Medical Claims and Billing degree : 2009
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